scholarly journals Post-COVID-19 illness trajectory: a multisystem investigation.

2021 ◽  
Author(s):  
Colin Berry ◽  
Andrew Morrow ◽  
Robert Sykes ◽  
Alasdair McIntosh ◽  
Anna Kamdar ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Renal Involvement ◽  
Illness Perception ◽  
Kidney Injury ◽  
Outcome Evaluation ◽  
Lung Damage ◽  
Oxygen Utilization ◽  
Post Discharge ◽  
Illness Trajectory ◽  
Related Quality

Abstract Background: The pathophysiology and trajectory of multiorgan involvement in post-COVID-19 syndrome is uncertain. Methods: A prospective, multicenter, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated 28-60 days post-discharge (visit 2). Multisystem investigations included chest computed tomography with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, digital electrocardiography, and multisystem biomarkers. The primary outcome was the adjudicated likelihood of myocarditis.Results: 161 patients (mean age 55 years, 43% female) and 27 controls with similar age, sex, ethnicity, and vascular risk factors were enrolled from 22 May 2020 to 2 July 2021 and had a primary outcome evaluation. Compared to controls, at 28-60 days post-discharge, patients with COVID-19 had persisting evidence of cardio-renal involvement, systemic inflammation, and hemostasis pathway activation. Myocarditis was adjudicated as being not likely (n=17; 10%), unlikely (n=56; 35%), probable (n=67; 42%) or very likely (n=21; 13%). Acute kidney injury (odds ratio, 95% confidence interval: 3.40 (1.13, 11.84); p=0.038) and low hemoglobin A1c (0.26 (0.07, 0.87); p=0.035) were multivariable associates of adjudicated myocarditis. During convalescence, compared to controls, COVID-19 was associated with worse health-related quality of life (EQ5D-5L) (p<0.001), illness perception (p<0.001), anxiety and depression (p<0.001), physical activity (p<0.001) and predicted maximal oxygen utilization (ml/kg/min) (p<0.001). These measures were associated with adjudicated myocarditis.Conclusions: The illness trajectory of COVID-19 includes persisting cardio-renal inflammation, lung damage and hemostasis activation. Adjudicated myocarditis occurred in one in eight hospitalized patients and was associated with impairments in health status, physical and psychological wellbeing during community convalescence. Public registration: ClinicalTrials.gov identifier is NCT04403607.

scholarly journals Mass Screening Is Associated with Low Rates of Acute Kidney Injury among COVID-19 Patients in Hong Kong

2021 ◽  
pp. 1-12
Author(s):  
Kam Wa Chan ◽  
Ivan Fan-Ngai Hung ◽  
Owen Tak-Yin Tsang ◽  
Tak Chiu Wu ◽  
Eugene Yuk-Keung Tso ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hong Kong ◽  
Mass Screening ◽  
Symptom Onset ◽  
Screening Program ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Disease Course ◽  
Post Discharge ◽  
Prolonged Hospitalization

<b><i>Introduction:</i></b> Renal involvement in COVID-19 is less well characterized in settings with vigilant public health surveillance, including mass screening and early hospitalization. We assessed kidney complications among COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation, and mortality. <b><i>Methods:</i></b> Linked electronic records of all patients with confirmed COVID-19 from 5 major designated hospitals were extracted. Duplicated records due to interhospital transferal were removed. Primary outcome was the incidence of in-hospital acute kidney injury (AKI). Secondary outcomes were AKI-associated mortality, incident renal replacement therapy (RRT), intensive care admission, prolonged hospitalization and disease course (defined as &#x3e;90th percentile of hospitalization duration [35 days] and duration from symptom onset to discharge [43 days], respectively), and change of estimated glomerular filtration rate (GFR). Patients were further stratified into being symptomatic or asymptomatic. <b><i>Results:</i></b> Patients were characterized by young age (median: 38.4, IQR: 28.4–55.8 years) and short time (median: 5, IQR: 2–9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. The median time from symptom onset to in-hospital AKI was 15 days. AKI increased the odds of prolonged hospitalization and disease course by 2.0- and 3.5-folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 mL/min/1.73 m<sup>2</sup> versus baseline (upon admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%, <i>n</i> = 3/62) and symptomatic (3.7%, <i>n</i> = 19/519) patients. <b><i>Conclusion:</i></b> The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.

scholarly journals MO386MASS SCREENING AND THE LOW RATES OF ACUTE KIDNEY INJURY AMONG COVID-19 PATIENTS IN HONG KONG

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Kam Wa Chan ◽  
Ivan Fan-Ngai Hung ◽  
Owen Tak-Yin Tsang ◽  
Tak Chiu Wu ◽  
Eugene Yuk-Keung Tso ◽  
...  
Keyword(s):  
Hong Kong ◽  
Symptom Onset ◽  
Screening Program ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Disease Course ◽  
Post Discharge ◽  
Prolonged Hospitalization ◽  
Duration Of Hospitalization ◽  
Asymptomatic Subjects

Abstract Background and Aims Renal involvement in COVID-19 under vigilant public health surveillance, including mass screening and early hospitalization is less well-characterized. We assessed renal involvement of COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation and mortality. Method Linked electronic records of all confirmed patients from 5 major designated hospitals were extracted. Primary outcome was the incidence of in-hospital AKI. Secondary outcomes were AKI-associated mortality, incident RRT, intensive care admission, prolonged hospitalization and disease course (defined as &gt;90th percentile of hospitalization duration and duration from symptom onset to discharge, respectively), and change of eGFR. Patients were further stratified into being symptomatic or asymptomatic. Results Patients were characterized by young age (median:38.4, IQR:28.4-55.8 years old) and short time (Median:5, IQR:2-9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. AKI increased the odds of prolonged hospitalization and disease course by 2.0 and 3.5 folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 ml/min/1.73m2 versus baseline (at admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%) and symptomatic (3.7%) patients. Conclusion The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.

scholarly journals Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318650
Author(s):  
Robbie Sparrow ◽  
Shubrandu Sanjoy ◽  
Yun-Hee Choi ◽  
Islam Y Elgendy ◽  
Hani Jneid ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Left Atrial Appendage ◽  
Kidney Injury ◽  
Complication Rates ◽  
Left Atrial Appendage Closure ◽  
Black Patients ◽  
Comorbidity Burden ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Major Adverse Events

ObjectiveThis manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC).MethodsThe US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke.ResultsOf 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and ‘other’ race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of ‘other’ race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles.ConclusionIn this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.

scholarly journals Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 627
Author(s):  
Pierluigi Marzuillo ◽  
Anna Di Sessa ◽  
Pier Luigi Palma ◽  
Giuseppina Rosaria Umano ◽  
Cesare Polito ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Tubular Damage ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Type 2 Diabetes Mellitus (T2DM) is a main cause of chronic kidney disease (CKD) in adulthood. No studies have examined the occurrence of acute kidney injury (AKI)—that enhances the risk of later CKD—and renal tubular damage (RTD)—that can evolve to AKI—in children with onset of T2DM. We aimed to evaluate the prevalence and possible features of AKI and RTD in a prospectively enrolled population of children with onset of T2DM. We consecutively enrolled 10 children aged 12.9 ± 2.3 years with newly diagnosed T2DM. AKI was defined according to the KDIGO criteria. RTD was defined by abnormal urinary beta-2-microglobulin and/or tubular reabsorption of phosphate (TRP) < 85% and/or fractional excretion of Na > 2%. None of the patients developed AKI, whereas 3/10 developed RTD with high beta-2-microglobulin levels (range: 0.6–1.06 mg/L). One of these three patients also presented with reduced TRP levels (TRP = 70%). Proteinuria was observed in two out of three patients with RTD, while none of patients without RTD had proteinuria. Patients with RTD presented higher beta-2-microglobulin, acute creatinine/estimated basal creatinine ratio, and serum ketones levels compared with patients without RTD. In conclusion, in our pilot observation, we found that none of the 10 children with T2DM onset developed AKI, whereas three of them developed RTD.

scholarly journals Proteinuria Indicates Decreased Normal Glomeruli in ANCA-Associated Glomerulonephritis Independent of Systemic Disease Activity

2021 ◽  
Vol 10 (7) ◽  
pp. 1538
Author(s):  
Désirée Tampe ◽  
Peter Korsten ◽  
Philipp Ströbel ◽  
Samy Hakroush ◽  
Björn Tampe
Keyword(s):  
Disease Activity ◽  
Systemic Disease ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Clinicopathological Characteristics ◽  
Renal Outcome ◽  
Study Results ◽  
Renal Biopsies ◽  
Stage Renal Disease

Background: Renal involvement is a common and severe complication of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), potentially resulting in a pauci-immune necrotizing and crescentic ANCA glomerulonephritis (GN) with acute kidney injury (AKI), end-stage renal disease (ESRD) or death. There is recent evidence that the degree of proteinuria at diagnosis is associated with long-term renal outcome in ANCA GN. Therefore, we here aimed to systematically describe the association between proteinuria and clinicopathological characteristics in 53 renal biopsies with ANCA GN and corresponding urinary samples at admission. Methods: A total number of 53 urinary samples at admission and corresponding renal biopsies with confirmed renal involvement of AAV were retrospectively included from 2015 to 2021 in a single-center study. Results: Proteinuria correlated with myeloperoxidase (MPO) subtype, diagnosis of microscopic polyangiitis (MPA) and severe deterioration of kidney function. Proteinuria was most prominent in sclerotic class ANCA GN and ANCA renal risk score (ARRS) high risk attributed to nonselective proteinuria, including both glomerular and tubular proteinuria. Finally, there was no association between proteinuria and systemic disease activity, suggesting that proteinuria reflected specific renal involvement in AAV rather that systemic disease activity. Conclusions: In conclusion, proteinuria correlated with distinct clinicopathological characteristics in ANCA GN, mostly attributed to a reduced fraction of normal glomeruli. Furthermore, proteinuria in ANCA GN reflected specific renal involvement in AAV rather than systemic disease activity. Therefore, urinary findings could further improve our understanding of mechanisms promoting kidney injury and progression of ANCA GN.

Metastatische pulmonale calcificaties als zeldzame oorzaak van matglasopaciteiten op een CT-scan

2021 ◽  
Author(s):  
I. CARPENTIER ◽  
E. PEETERS ◽  
B. VANZIELEGHEM
Keyword(s):  
Correct Diagnosis ◽  
Kidney Injury ◽  
Lung Damage ◽  
Ground Glass ◽  
Literature Overview ◽  
Chronic Kidney Injury ◽  
Patient’S History ◽  
Pulmonary Calcifications ◽  
Metastatic Pulmonary Calcification

Metastatic pulmonary calcification: a case report and literature overview Ground-glass opacities have a broad differential diagnosis, including infectious, metabolic, inflammatory and malignant causes. This case presents an underdiagnosed entity of dense ground-glass opacities, namely metastatic pulmonary calcifications (MPC). This is a benign metabolic disease characterised by the deposition of calcium in the lungs, mostly described in patients with chronic kidney injury and secondary hyperparathyroidism. The majority of the patients require no treatment, but in some cases it may lead to irreversible lung damage. Clinical and radiological features, as well as the patient’s history, are crucial to make a correct diagnosis since MPC has a relatively specific appearance on imaging. This case study discusses the medical history and imaging appearance of a 44-year-old woman with MPC, followed by a literature overview.

Health-related quality-of-life among survivors of acute kidney injury in the intensive care unit: a systematic review

2015 ◽  
Vol 42 (2) ◽  
pp. 137-146 ◽  
Author(s):  
Pierre-Marc Villeneuve ◽  
Edward G. Clark ◽  
Lindsey Sikora ◽  
Manish M. Sood ◽  
Sean M. Bagshaw
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

scholarly journals A qualitative exploration of the experience and quality of life of patients, and their family carers, admitted to a specialist eye hospital with microbial keratitis

2020 ◽  
Author(s):  
Shelley Anne Tranter ◽  
Maria Cabreras-Aguas ◽  
Mandy Riddell ◽  
Joanna McCulloch ◽  
Therese Riley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Qualitative Interviews ◽  
Family Carers ◽  
Microbial Keratitis ◽  
Structured Interviews ◽  
Post Discharge ◽  
Convenience Sample ◽  
Family Work ◽  
Related Quality

Abstract Background: Microbial keratitis is a vision-threatening condition requiring intensive treatment. Understanding patients’ and carers’ experience during and after hospitalisation can inform improvements in care and outcomes. This study explored the vision-related quality of life, and the experiences of patients with microbial keratitis and their family carers when admitted to a quaternary referral eye hospital in AustraliaMethods: The study employed mixed methods, including qualitative interviews and a survey in hospital and a telephone interview post-discharge. A convenience sample was recruited of 33 patients with microbial keratitis who presented to hospital between March and October 2017, and 10 of their family carers. Semi-structured interviews were audiotaped, transcribed verbatim, coded and analysed using thematic analysis. Patient participants completed the National Eye Institute Visual Functioning Questionnaire – 25 (NEIVFQ-25).Results: Qualitative analyses identified two main themes: Saving sight, with subthemes of costs of saving sight, and travel and transportation; Safe-guarding home and normal life with subthemes of family, work and pastimes. A group mean NEIVFQ-25 score of 74 was similar to other ophthalmic disease groups but pain scores were higher.Conclusion: Findings provide insights into the experiences and often unspoken concerns of microbial keratitis patients and their family carers, revealing the priority and the associated costs of saving sight, and the implications for family and lifestyles. These patients reported similarly reduced vision-related quality of life but greater pain compared to other ophthalmic groups. Findings point to ways to improve their experience and potentially reduce the high rates of unplanned representations of this patient group.

scholarly journals Vision-related Quality of Life in Patients With Glaucoma: the Role of Illness Perceptions

2021 ◽  
Author(s):  
Qiqi Zhang ◽  
Wenzhe Zhou ◽  
Di Song ◽  
Yanqian Xie ◽  
Hao Lin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Illness Perceptions ◽  
Linear Regression Analysis ◽  
Illness Perception ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Illness Perception Questionnaire ◽  
Related Quality

Abstract Purpose: To explore the predictive effect of illness perceptions on vision-related quality of life (VRQoL) in Chinese glaucoma patients.Methods: In this cross-sectional study, 97 patients with glaucoma completed the Brief Illness Perception Questionnaire (BIPQ), the Glaucoma Quality of Life-15 (GQL-15), and a questionnaire with sociodemographic and clinical information. Correlation analysis and hierarchical linear regression analysis were performed.Results: The BIPQ total score was positively correlated with the scores of the total GQL-15 and its four dimensions. Chronic comorbidities, type of glaucoma, best-corrected visual acuity (BCVA), mean defect (MD) of visual field in the better eye, and identity in the BIPQ were the critical predictors of VRQoL. Illness perceptions independently accounted for 7.8% of the variance in the VRQoL of glaucoma patients.Conclusions: Patients with stronger illness perceptions who perceive themselves as having more glaucoma symptoms are likely to experience worse VRQoL. Illness perceptions in glaucoma patients deserve clinical attention, and further studies are needed to examine whether cognitive interventions targeting illness perceptions can improve VRQoL.

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